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Journal of Nursing

It Is Time to Openly Assess & Discuss Mental Illness

Maureen Kroning RN EdD maureenkron[email protected]


Unfortunately, most of us know someone who has suffered with mental illness. According to National Institute of Mental Health (NIMH) (2013) there are approximately 9 million adults in the US with a serious mental illness. According to the CDC (2013) mental illness generally displays a dysregualtion of mood, thought and or behavior and is often characterized by manifestations that can occur within seconds such as: anger, suicidal tendencies and aggression towards self and or others.

With the prevalence of mental illness on the rise, nurses in all healthcare settings are going to be tasked with providing care for patients with a mental disorder. Thus, it is necessary to provide nurses with the skills necessary to care for patients with mental illness. In preparing nursing students to become Registered Nurses (RN) they must complete a mental health clinical rotation. It is not uncommon for nursing students to verbalize their fear and apprehension of completing their mental health clinical rotation. As a nurse educator it is essential that nursing students and nurses are provided with the tools necessary to provide care to patients, families and communities affected by mental illness.

It is finally the time in our society to openly discuss mental illness and to look for reasons why we are facing this increase in mental illness. According to World Psychiatry (2002) a large percentage of individuals suffering with serious mental illness not only struggle with the symptoms and disabilities of their disease, they also face the stereotypes and prejudice that accompanies their mental illness. The stereotypes and prejudices can adversely affect every aspect of the mentally ill person’s life. As healthcare professionals we need to assess our patient’s needs and more importantly what can we do to help our patients meet their healthy holistic needs.

Every person has their own unique needs that fulfill them both emotionally and psychologically. When a person’s needs are not being met this can increase the risk of illness, not only physical illness but mental illness as well. Albert Maslow placed human needs in a hierarchy of order where one must meet each need starting at the bottom of the needs list and continuing upward in order to reach the highest need of self-actualization (Boeree, 2006).

Looking at Maslow’s theory one can surmise that unless we actually meet and master the physiological needs which includes that of breathing, food & water then one cannot master the need of safety which includes security of body, employment, resources and morality. Maslow believed that if safety needs are not met then love and belonging such as friendship and family cannot be met fully. Furthermore, if one’s survival need is threatened one will regresses to a lower level need as is love and belonging needs must be met in order to achieve self-esteem needs such as: confidence, achievement and respect of self and others (Boeree, 2006). If these lower needs are not met then one cannot achieve self-actualization, the highest level need, which includes a sense of morality, being able to problem solve, having autonomy, reality-centered thinking and meaningful personal relationships.

When talking to patients with a history of mental illness there is often the unveiling that certain needs have been unmet. Recently, I took a group of nursing students to a Veterans of America (VA) hospital to care for patients seeking mental health services. It was during this clinical experience that I realized just how Maslow’s theory can be applied for mental health nursing. The one common denominator among this group of patients, at the VA, was that they were all veterans and had served their country yet, seemingly unaware of what effect this would have on their ability to achieve self-actualization, Maslow’s highest achievement need.

The veterans had their most basic need, the need for safety, compromised and often stripped away when they went in to serve their country. Many of the veterans voiced not only a fear of their own life but of the lives of those they served with and even the lives of those they were in war against. How can we expect the next of Maslowe’s needs, that of love and belonging which encompasses fulfilling that of friendship & family, not be affected and if the need of safety has not been met and then further the need for self-esteem which includes that of confidence, achievement and respect of themselves and others not be affected and so on till according to Maslow there is no chance of self-actualization to occur until each of these prior needs have been met. Perhaps this is the answer to our mental health question, “Why do we have so many people suffering in this country with mental illness?”

Perhaps, the answer to that exact question is that those suffering with mental illness have not had their basic needs met in the order Maslow has theorized which becomes necessary in order to achieve self-actualization. According to Psychology Dictionary (2013) self-actualization is the realization of what you can become, what you are capable of becoming. According to Mind Development (2013) societal hindrances prevent one from achieving self-actualization or reaching one’s true potential in life and in order to prevent the hindrances from preventing self-actualization one must awaken to their situation and recognize that their life can change in the direction of achieving self-actualization and personal growth. Nurses play a large role in assisting patients who suffer with mental illness change their life in a direction that can attain personal growth or self-actualization.

Nurses, play a vital role in assisting patients to awaken to their situation and recognize that they can change their life and achieve self-actualization. It is essential that nurses are provided with the tools necessary to do this. Patient assessment is the first step in the nursing process. Assessing for mental illness is necessary in order to provide safe and competent care. Using a tool that incorporates Maslowe’s hierarchy of needs to assess if a patient feels that their needs are being met or not met is a good first step to begin assessing the mental health status of our patients. It is time to discuss openly about mental illness. Perhaps, asking questions to assess each individuals unique needs can provide the valuable insight needed to help patient suffering with mental illness achieve authenticity of self and become aware of their inner needs and recognize their talents and valued worth.

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